Diagnosis
Depending on the cause, different means of diagnosis can be used. However, in most cases the classical methods are ultrasound (sonography), MRI during pregnancy (=magnetic resonance imaging) and CT (=computer tomography). Especially in view of the radiation exposure for the unborn child, all procedures leading to a diagnosis are well balanced.
Only MRI can be performed during pregnancy without radiation exposure. But even here there are strict restrictions: X-ray diagnostics is the method of first choice for gestational pelveopathy. Cytology and colposcopy play an important role if cervical cancer is suspected.
These include taking a smear of the epithelium of the cervix and inspecting the cervix with a colposcope. Not to be forgotten is a good anamnesis interview with the patient, in order to be able to already narrow down possible causes for coccyx pain during pregnancy. The pain history includes the location, type, frequency and intensity of pain. Furthermore, it is relevant to know since when the coccyx pain has existed, whether the pain radiates and whether the patient can put the pain into a causal relationship (for example, a fall on the coccyx).Finally, the attending physician should ask if any pain relief measures have already been taken, if so, which ones, and if there are positions in which the coccyx pain is stronger or weaker.
Which doctor treats coccyx pain during pregnancy?
The first point of contact regarding pain during pregnancy should be the gynecologist. In general, coccyx pain is a common occurrence during pregnancy and is not a cause for concern. Nevertheless, in a few cases another cause for coccyx pain may be possible. In order to rule out a possible unnatural cause for your coccyx pain, you should consult your gynaecologist accordingly. Your gynecologist can then refer you to an orthopedic surgeon or physiotherapist, who can then treat the coccyx pain in a targeted manner.
Therapy
Here, too, the type of therapy depends in part on the cause of the coccyx pain. The first priority is to alleviate the symptoms, i.e. to treat the pain. This can be done with analgesics (painkillers) such as paracetamol.
In contrast to ASA, paracetamol may also be taken during pregnancy. The active ingredient acetylsalicylic acid (ASA) has another undesirable effect, namely an early closure of the ductus botalli, a special connection between the aorta and the pulmonary trunk (pulmonary arteries) in the child’s bloodstream. Furthermore, ASA inhibits blood clotting, so that it may only be taken until the end of the 37th week of pregnancy, if at all, otherwise there is an increased risk of bleeding during birth.
Paracetamol is therefore the preferred painkiller during pregnancy. In addition to drug treatment, there are other useful therapeutic measures. Especially during pregnancy, coccyx pain can be relieved by using a seat cushion or lap belt.
An important starting point of the therapy is the musculature. If the coccyx pain results from muscular tension, heat therapy is helpful (for example with heat plasters such as ThermaCare®). In general, it is also useful to choose a muscle relaxing but also muscle building therapy.
Tense muscles can be loosened by massage or physiotherapy so that the coccyx pain is less severe over time. The background of muscle building is to strengthen both the back and the pelvic floor muscles in order to achieve better stability. If the coccyx pain is due to nerve entrapment, acupuncture as a therapeutic tool can alleviate the symptoms.
As a rule, all the conservative therapeutic approaches mentioned above are sufficient to combat coccyx pain. Only in the case of a coccyx fracture is there possibly an indication for surgery, in which resection, i.e. removal of the bone portion, is performed. Since the coccyx represents the lowest bony end structure, removal is relatively unproblematic.
Unfortunately, it is not possible to say in general terms that coccyx pain will improve again after pregnancy. In some cases, the coccyx pain is only triggered by the birth process and therefore only occurs after birth. Exercises to treat coccyx pain are especially helpful if there is a muscular cause.
In this case, in addition to more exercise and the use of a coccyx cushion, training the pelvic floor and back muscles usually helps.
- Exercise 1: Starting position: four-footed stand (resting on the floor with both palms of hands, knees and shins) -The pelvis should be tilted upwards during this exercise. Vertebra by vertebra, slowly form an arch with the spine.
When a maximum curved position is reached, it is held for a few seconds. Finally, the pelvis is tilted downward and the curvature is slowly dissolved.
- Exercise 2: Starting position: Lying on your back, arms relaxed and laid to the side, feet raised at a distance of about twenty centimeters. The gluteal muscles should be fully tensed (throughout the exercise!)
and the buttocks and abdomen should be lifted towards the ceiling. The knees must not touch each other and the distance between them should remain the same. The position is then held for a few seconds.
Then slowly put the buttocks on the floor again. The shoulders should not lift off the floor at any time.
- Exercise 3: Starting position: Tailor’s seat, straight back. In this exercise the tension of the pelvic floor muscles should be actively perceived.
Tense the muscles strongly and feel how the pelvic floor rises. The position and tension should be held for a few seconds.The exercise can be repeated as often as desired with short relaxation phases.
The seat ring is a seat cushion with a hole in the middle. This seat ring is usually made of an inflatable plastic or foam.
Such a seat ring can be helpful in case of pain in the coccyx, after operations or even during and after pregnancy. Sitting on a seat ring is intended to create a hollow seat that relieves the coccyx, the anal region and the spine. The soft materials ensure that the user can spend a long time on the seat ring without new tensions.
As a result, a painless, comfortable sitting should be guaranteed. For coccyx pain in general or especially during pregnancy, so-called kinesiology tapes can help in addition to physiotherapy. It is generally accepted, however, that “taping” should be used as a supporting and bridging measure until physiotherapy, not as the sole therapy.
Probably the most important effect of “Taping” is pain relief. This is achieved by the tension and pressure stimuli that the tape produces on the skin surface. The tension and pressure activate nerve endings under the skin surface, which in turn can transmit signals to the spinal cord. A chain reaction can thus reduce muscle tone and muscle tension, resulting in perceived pain relief. To apply the tape correctly to the back, you should consult a trained person.
